Bloqueio do plano do eretor da espinha com técnica de múltiplos cateteres para esofagectomia aberta: relato de caso

Background and objective

Erector spinae plane block is a valid technique to provide simultaneously analgesia for combined thoracic and abdominal surgery.

上海市浦东新区基层全科医师心身医学项目培训效果评估*

目的在上海市浦东新区全科医师队伍中开展心身医学知识培训。方法采用问卷星平台进行问卷调查,选取辖区内45家社区卫生服务中心参加培训的135名学员作为培训组,未参加培训的100名全科医师作为对照组,进行培训效果评估。结果培训组总分高于对照组,差异有显著统计学意义(P0.001),培训后,提升最快的模块依次是心身医学知识的应用(P0.001)、精神科问诊及治疗(P0.001)、社区随访沟通技巧(P0.001)和儿童青少年心身疾病(P=0.002),但焦虑症模块的变化差异无统计学意义(P=0.213);相对于城区的全科医师,乡镇的全科医师培训后,精神科问诊及治疗(P=0.471)和儿童青少年心身疾病(P=0.06)模块的变化均无统计学意义。结论心身医学培训能显著提升全科医师对相应知识的掌握,城区和乡镇的全科医师对心身医学知识的需求有差别,需要进一步精确设计培训模式和方向。     

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

Objective: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). Methods: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed‐methods approach. Results: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. Conclusion: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow‐up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. Implications: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.     

全麻复合硬膜外麻醉对肺癌根治术患者外周血T细胞亚群及NK细胞活性的影响

目的探讨全麻复合硬膜外麻醉对肺癌根治术患者外周血T细胞亚群及NK细胞活性的影响。方法收集接受肺癌根治术的84例患者的病历资料,按照患者所行麻醉方式的不同对其进行分组,单纯行全麻者42例归为对照组,行全麻复合硬膜外麻醉者42例纳入观察组,分析不同麻醉方式对患者外周血T细胞亚群及NK细胞活性影响的差异性。结果术后24 h观察组与对照组患者的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、NK细胞水平均较术前明显降低,且术后24 h相比对照组患者的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、NK细胞水平,观察组患者以上指标水平明显更高(P<0.05)。术后1周2组患者的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平与术前相比并无明显差异(P>0.05),但NK细胞水平较术前明显降低(P<0.05),且术后1周相比对照组患者,观察组患者的NK细胞水平更高(P<0.05)。观察组患者的术后苏醒时间、术后拔管时间、自主呼吸恢复时间均明显短于对照组患者,2组差异有统计学意义(P<0.05)。结论相比单纯全麻,全麻复合硬膜外麻醉对肺癌根治术患者外周血T细胞亚群及NK细胞活性的影响更小,有助于患者术后的恢复。     

Taking stock of what is known about faculty development in competency-based medical education: A scoping review paper

Abstract

Purpose: The primary objective was to inventory what is currently known about faculty development (FD) for competency-based medical educations (CBME) and identify gaps in the literature.

Methods: A scoping review methodology was employed. Inclusion criteria for article selection were established with two reviewers completing a full-text analysis. Quality checks were included, along with iterative consultation on data collection and consensus decision making via a grounded theory approach.

Results: The review identified 19 articles published between 2009 and 2018. Most articles (N?=?15) offered suggestions as to what should happen with FD in CBME, but few (N?=?4) adopted an experimental design. Six main themes were identified with three main features of FD noted across themes: (1) The importance of direct and timely feedback to faculty members on their teaching and assessment skills. (2) The role of establishing shared mental models for CBME curricula. (3) That FD is thought of longitudinally, not as a one-time bolus.

Conclusion: This work illustrates that there is limited, high quality research in FD for CBME. Future FD activities should consider employing a longitudinal and multi-modal program format that includes feedback for the faculty participants on their teaching and assessments skills, including the development of faculty coaching skills.     

Bloqueo ecoguiado bajo el músculo multífido para el dolor postoperatorio tras cirugía de columna lumbar: serie prospectiva de casos

We describe a series of 15 patients scheduled for single level lumbar spine decompression with instrumentation receiving ultrasound (US) guided submultifidus block (SMFB). In this series, injections of local anesthetic deep to the multifidus muscle provided reliable block of dorsal rami of spinal nerves at multiple levels. With US, the multifidus muscle can be identified both in axial and parasagittal planes. Needle tip is easily visualized beneath the multifidus and medial to the transverse process. Good quality analgesia was documented by pain scores. There were no adverse events. Further studies are needed to compare this nerve block with routine multimodal analgesia or with the recently described thoracolumbar interfascial plane block to compare safety and analgesic efficacy.     

Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use

BackgroundCesarean delivery is one of the most common surgeries performed worldwide and the adoption of enhanced recovery programs for cesarean delivery is gaining popularity. We tested the hypothesis that implementation of an enhanced recovery program for cesarean delivery would be associated with a decrease in postoperative opioid consumption.MethodsWe compared a retrospective cohort of women delivered by elective cesarean delivery (January 1, 2017 to June 30, 2018) to a prospective cohort exposed to the enhanced recovery protocol (July 1, 2018 to December 31, 2018). The primary outcome was inpatient maternal opioid use, measured as total oral morphine equivalents. Secondary outcomes included postoperative 0–10 pain scores, length of stay, 30-day postoperative complication rates, and hospital re-admissions.ResultsData from 541 patients were analyzed. The enhanced recovery cohort used significantly less oral morphine equivalents compared with the pre-enhanced recovery cohort (60.3 mg vs 104.3 mg, P <0.001). The number of patients who required opioid medication within 24 h of discharge was significantly reduced in the enhanced recovery cohort (41.1% vs 74.6%, P <0.001). There were no significant differences in average pain scores (1.6 vs 1.9, P=0.037).ConclusionsThe implementation of an enhanced recovery program for cesarean delivery was associated with a significant reduction in postoperative opioid consumption throughout hospitalization, with average pain scores remaining <2. Implementation of this program was also associated with an increase in the number of patients who were opioid-free 24 h prior to discharge.